AAGP Annual Meeting

LOS ANGELES – A collaborative-care model for depression management resulted in significantly greater reductions in depression scores and treatment response, compared with usual care, among 186 older adults included in a records review.

After 6 months of treatment, the mean score on the nine-item depression scale of the Patient Health Questionnaire (PHQ-9) was significantly lower for 93 patients enrolled in the collaborative-care model than for 93 patients who received usual care (6.42 vs. 13.19). The mean improvement in PHQ-9 score from baseline also was significantly greater in the collaborative-care group, Dr. Ramona DeJesus reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

Antidepressant medication use was similar in the two groups at 6 months, said Dr. DeJesus, an internist and assistant professor of medicine at the Mayo Clinic in Rochester, Minn.

Collaborative-care models that bring primary care providers and psychiatrists together to care for patients have been shown in numerous studies to be more effective than usual care for the management of depression. One such model – Depression Improvement Across Minnesota, Offering a New Direction (DIAMOND) – was implemented in March 2008 at primary care sites at the Mayo Clinic.

The DIAMOND program, which was developed by the Institute for Clinical Systems Improvement, provides for consistent patient assessment, a registry that tracks treatment response over time, and a focus on relapse prevention. The model involves a primary care manager and a liaison or consultative relationship with a psychiatrist, Dr. DeJesus explained in an interview.

In a prior study, she found that patients treated using the collaborative-care model had significantly greater use of antidepressant medications after 1 year, compared with those receiving usual care, but a subgroup analysis of those over age 65 years in that study did not yield similar results.

For the current study, medical records of patients aged 65 years and older who had received a diagnosis of depression between March 2008, when the DIAMOND program was implemented, and December 2010 were reviewed. All had a screening score of 10 or greater on the PHQ-9. The collaborative-care and usual-care patient groups were similar with respect to demographic characteristics, including age, gender, race, ethnicity, marital status, and baseline PHQ-9 score.

As in the earlier trial, these findings show that antidepressant use is not increased among older adults treated using a collaborative-care model. This might be a result of increased caution with respect to prescribing in older adults, Dr. DeJesus said.

"The collaborative-care model consistently demonstrates efficacy across both young and elderly populations," she said, noting that the current findings provide further support for use of this model in the elderly population.

Dr. DeJesus reported having no disclosures.

LOS ANGELES – A collaborative-care model for depression management resulted in significantly greater reductions in depression scores and treatment response, compared with usual care, among 186 older adults included in a records review.

After 6 months of treatment, the mean score on the nine-item depression scale of the Patient Health Questionnaire (PHQ-9) was significantly lower for 93 patients enrolled in the collaborative-care model than for 93 patients who received usual care (6.42 vs. 13.19). The mean improvement in PHQ-9 score from baseline also was significantly greater in the collaborative-care group, Dr. Ramona DeJesus reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

Antidepressant medication use was similar in the two groups at 6 months, said Dr. DeJesus, an internist and assistant professor of medicine at the Mayo Clinic in Rochester, Minn.

Collaborative-care models that bring primary care providers and psychiatrists together to care for patients have been shown in numerous studies to be more effective than usual care for the management of depression. One such model – Depression Improvement Across Minnesota, Offering a New Direction (DIAMOND) – was implemented in March 2008 at primary care sites at the Mayo Clinic.

The DIAMOND program, which was developed by the Institute for Clinical Systems Improvement, provides for consistent patient assessment, a registry that tracks treatment response over time, and a focus on relapse prevention. The model involves a primary care manager and a liaison or consultative relationship with a psychiatrist, Dr. DeJesus explained in an interview.

In a prior study, she found that patients treated using the collaborative-care model had significantly greater use of antidepressant medications after 1 year, compared with those receiving usual care, but a subgroup analysis of those over age 65 years in that study did not yield similar results.

For the current study, medical records of patients aged 65 years and older who had received a diagnosis of depression between March 2008, when the DIAMOND program was implemented, and December 2010 were reviewed. All had a screening score of 10 or greater on the PHQ-9. The collaborative-care and usual-care patient groups were similar with respect to demographic characteristics, including age, gender, race, ethnicity, marital status, and baseline PHQ-9 score.

As in the earlier trial, these findings show that antidepressant use is not increased among older adults treated using a collaborative-care model. This might be a result of increased caution with respect to prescribing in older adults, Dr. DeJesus said.

"The collaborative-care model consistently demonstrates efficacy across both young and elderly populations," she said, noting that the current findings provide further support for use of this model in the elderly population.

Dr. DeJesus reported having no disclosures.

LOS ANGELES – A collaborative-care model for depression management resulted in significantly greater reductions in depression scores and treatment response, compared with usual care, among 186 older adults included in a records review.

After 6 months of treatment, the mean score on the nine-item depression scale of the Patient Health Questionnaire (PHQ-9) was significantly lower for 93 patients enrolled in the collaborative-care model than for 93 patients who received usual care (6.42 vs. 13.19). The mean improvement in PHQ-9 score from baseline also was significantly greater in the collaborative-care group, Dr. Ramona DeJesus reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

Antidepressant medication use was similar in the two groups at 6 months, said Dr. DeJesus, an internist and assistant professor of medicine at the Mayo Clinic in Rochester, Minn.

Collaborative-care models that bring primary care providers and psychiatrists together to care for patients have been shown in numerous studies to be more effective than usual care for the management of depression. One such model – Depression Improvement Across Minnesota, Offering a New Direction (DIAMOND) – was implemented in March 2008 at primary care sites at the Mayo Clinic.

The DIAMOND program, which was developed by the Institute for Clinical Systems Improvement, provides for consistent patient assessment, a registry that tracks treatment response over time, and a focus on relapse prevention. The model involves a primary care manager and a liaison or consultative relationship with a psychiatrist, Dr. DeJesus explained in an interview.

In a prior study, she found that patients treated using the collaborative-care model had significantly greater use of antidepressant medications after 1 year, compared with those receiving usual care, but a subgroup analysis of those over age 65 years in that study did not yield similar results.

For the current study, medical records of patients aged 65 years and older who had received a diagnosis of depression between March 2008, when the DIAMOND program was implemented, and December 2010 were reviewed. All had a screening score of 10 or greater on the PHQ-9. The collaborative-care and usual-care patient groups were similar with respect to demographic characteristics, including age, gender, race, ethnicity, marital status, and baseline PHQ-9 score.

As in the earlier trial, these findings show that antidepressant use is not increased among older adults treated using a collaborative-care model. This might be a result of increased caution with respect to prescribing in older adults, Dr. DeJesus said.

"The collaborative-care model consistently demonstrates efficacy across both young and elderly populations," she said, noting that the current findings provide further support for use of this model in the elderly population.

Dr. DeJesus reported having no disclosures.

LOS ANGELES – Prophylactic escitalopram reduces the risk for depression in patients undergoing treatment for head and neck cancer, according to findings from a randomized placebo-controlled trial involving 148 patients.

Of those randomized to receive the selective serotonin reuptake inhibitor, 10% developed moderate to severe depression during the course of their cancer treatment, compared with 24.6% of those who received placebo, Dr. William J. Burke reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

After adjustment for age, baseline smoking status, and stratification variables, including gender, cancer site, cancer stage, and primary treatment modality, those receiving active treatment remained significantly less likely to develop depression (hazard ratio, 0.37), said Dr. Burke of the University of Nebraska Medical Center, Omaha.

Of note, patients undergoing radiotherapy as the primary treatment modality were significantly more likely than those undergoing surgery as the primary treatment modality to develop depression (hazard ratio, 3.6).

Patients in the escitalopram group who did not become depressed during the course of the study reported a significantly better quality of life for 3 consecutive months after escitalopram cessation than those in either the treatment or placebo group who did develop depression, Dr. Burke noted.

Patients included in this double-blind study had head and neck cancers and were about to enter cancer treatment. Depression was assessed using the QIDS-SR(Quick Inventory of Depressive Symptomatology-Self Rated).

The findings have important implications for the management of patients entering treatment for head and neck cancer, which can be a particularly devastating disease. For example, larynx and tongue cancers comprise only 2% of all cancers, but patients with these cancers commit 19% of all cancer-related suicides, Dr. Burke noted.

Up to half of all patients with head and neck cancer develop major depressive disorder, which can adversely affect adherence to treatment, reduce quality of life, and result in significant morbidity and reduced survival.

"Preventing depression during the course of cancer treatment may, thus, be of great benefit," he said.

The project was supported by a grant from the National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMH or the National Institutes of Health. Additional support was provided by a research support fund grant from the Nebraska Medical Center and the University of Nebraska Medical Center. Forest Pharmaceuticals provided the matching placebo and drugs.

LOS ANGELES – Prophylactic escitalopram reduces the risk for depression in patients undergoing treatment for head and neck cancer, according to findings from a randomized placebo-controlled trial involving 148 patients.

Of those randomized to receive the selective serotonin reuptake inhibitor, 10% developed moderate to severe depression during the course of their cancer treatment, compared with 24.6% of those who received placebo, Dr. William J. Burke reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

After adjustment for age, baseline smoking status, and stratification variables, including gender, cancer site, cancer stage, and primary treatment modality, those receiving active treatment remained significantly less likely to develop depression (hazard ratio, 0.37), said Dr. Burke of the University of Nebraska Medical Center, Omaha.

Of note, patients undergoing radiotherapy as the primary treatment modality were significantly more likely than those undergoing surgery as the primary treatment modality to develop depression (hazard ratio, 3.6).

Patients in the escitalopram group who did not become depressed during the course of the study reported a significantly better quality of life for 3 consecutive months after escitalopram cessation than those in either the treatment or placebo group who did develop depression, Dr. Burke noted.

Patients included in this double-blind study had head and neck cancers and were about to enter cancer treatment. Depression was assessed using the QIDS-SR(Quick Inventory of Depressive Symptomatology-Self Rated).

The findings have important implications for the management of patients entering treatment for head and neck cancer, which can be a particularly devastating disease. For example, larynx and tongue cancers comprise only 2% of all cancers, but patients with these cancers commit 19% of all cancer-related suicides, Dr. Burke noted.

Up to half of all patients with head and neck cancer develop major depressive disorder, which can adversely affect adherence to treatment, reduce quality of life, and result in significant morbidity and reduced survival.

"Preventing depression during the course of cancer treatment may, thus, be of great benefit," he said.

The project was supported by a grant from the National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMH or the National Institutes of Health. Additional support was provided by a research support fund grant from the Nebraska Medical Center and the University of Nebraska Medical Center. Forest Pharmaceuticals provided the matching placebo and drugs.

LOS ANGELES – Prophylactic escitalopram reduces the risk for depression in patients undergoing treatment for head and neck cancer, according to findings from a randomized placebo-controlled trial involving 148 patients.

Of those randomized to receive the selective serotonin reuptake inhibitor, 10% developed moderate to severe depression during the course of their cancer treatment, compared with 24.6% of those who received placebo, Dr. William J. Burke reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

After adjustment for age, baseline smoking status, and stratification variables, including gender, cancer site, cancer stage, and primary treatment modality, those receiving active treatment remained significantly less likely to develop depression (hazard ratio, 0.37), said Dr. Burke of the University of Nebraska Medical Center, Omaha.

Of note, patients undergoing radiotherapy as the primary treatment modality were significantly more likely than those undergoing surgery as the primary treatment modality to develop depression (hazard ratio, 3.6).

Patients in the escitalopram group who did not become depressed during the course of the study reported a significantly better quality of life for 3 consecutive months after escitalopram cessation than those in either the treatment or placebo group who did develop depression, Dr. Burke noted.

Patients included in this double-blind study had head and neck cancers and were about to enter cancer treatment. Depression was assessed using the QIDS-SR(Quick Inventory of Depressive Symptomatology-Self Rated).

The findings have important implications for the management of patients entering treatment for head and neck cancer, which can be a particularly devastating disease. For example, larynx and tongue cancers comprise only 2% of all cancers, but patients with these cancers commit 19% of all cancer-related suicides, Dr. Burke noted.

Up to half of all patients with head and neck cancer develop major depressive disorder, which can adversely affect adherence to treatment, reduce quality of life, and result in significant morbidity and reduced survival.

"Preventing depression during the course of cancer treatment may, thus, be of great benefit," he said.

The project was supported by a grant from the National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMH or the National Institutes of Health. Additional support was provided by a research support fund grant from the Nebraska Medical Center and the University of Nebraska Medical Center. Forest Pharmaceuticals provided the matching placebo and drugs.

LOS ANGELES – Poor executive function ability in older patients with major depressive disorder was associated with reduced ability to implement emotion-regulation strategies in a prospective study involving 70 subjects.

The findings suggest that older patients with poor executive functioning might have a reduced capacity for benefiting from standard interventions for depression, such as cognitive-behavioral therapy, which rely on the implementation of emotion-regulation skills, Moria J. Smoski, Ph.D., reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

A total of 70 adults aged 60-87 years – 30 with major depressive disorder (MDD) and 40 without MDD – participated in the study. All subjects completed an emotion-regulation task involving stress induction achieved by ruminating for 2 minutes about a personally relevant stressor, followed by guided emotion regulation by either reappraisal or distraction techniques. A control group received no instruction on emotion regulation, said Dr. Smoski of Duke University Medical Center, Durham, N.C.

Mood was assessed using a three-item scale administered before and after stress induction, and at 1-minute intervals throughout the emotion-regulation phase. This protocol was repeated three times.

A subset of participants underwent neuropsychological executive-function testing, including a verbal fluency test (FAS) and assessment of task-switching and cognitive flexibility using the Trail Making Test-B (Trails B), Dr. Smoski said in an interview.

Subjects with MDD who had mid-level Trails B scores (scores at the 34th to 66th percentile) or high-level scores (scores at the 67th to 100th percentile) – indicating adequate or high levels of executive functioning – experienced significantly different degrees of negative affect reduction based on the emotion-regulation strategy used. The greatest decrease in negative affect scores was seen in those instructed to use distraction, followed by those instructed to use reappraisal and those who received no instruction on emotion regulation.

Subjects with low-level Trails B scores (scores at the 0 to 33rd percentile) – indicating poor executive function ability – experienced no benefit with use of any of the regulation strategies, Dr. Smoski said.

No Trails B–dependent effects were seen among those without MDD.

"Participants with low executive function ability may have less ability to capitalize on conscious emotion regulation–strategy use to manage negative affect," she noted.

The findings indicate that executive function moderates emotion regulation in late-life depression and might have important implications for treatment in this population, Dr. Smoski said.

Since patients with late-life depression and poor executive function may have reduced response to standard interventions, referral for behavioral-activation therapy – a "promising and interesting treatment approach" – merits consideration, she said.

This study was supported by grants from the National Institutes of Health. Dr. Smoski reported having no other disclosures.

LOS ANGELES – Poor executive function ability in older patients with major depressive disorder was associated with reduced ability to implement emotion-regulation strategies in a prospective study involving 70 subjects.

The findings suggest that older patients with poor executive functioning might have a reduced capacity for benefiting from standard interventions for depression, such as cognitive-behavioral therapy, which rely on the implementation of emotion-regulation skills, Moria J. Smoski, Ph.D., reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

A total of 70 adults aged 60-87 years – 30 with major depressive disorder (MDD) and 40 without MDD – participated in the study. All subjects completed an emotion-regulation task involving stress induction achieved by ruminating for 2 minutes about a personally relevant stressor, followed by guided emotion regulation by either reappraisal or distraction techniques. A control group received no instruction on emotion regulation, said Dr. Smoski of Duke University Medical Center, Durham, N.C.

Mood was assessed using a three-item scale administered before and after stress induction, and at 1-minute intervals throughout the emotion-regulation phase. This protocol was repeated three times.

A subset of participants underwent neuropsychological executive-function testing, including a verbal fluency test (FAS) and assessment of task-switching and cognitive flexibility using the Trail Making Test-B (Trails B), Dr. Smoski said in an interview.

Subjects with MDD who had mid-level Trails B scores (scores at the 34th to 66th percentile) or high-level scores (scores at the 67th to 100th percentile) – indicating adequate or high levels of executive functioning – experienced significantly different degrees of negative affect reduction based on the emotion-regulation strategy used. The greatest decrease in negative affect scores was seen in those instructed to use distraction, followed by those instructed to use reappraisal and those who received no instruction on emotion regulation.

Subjects with low-level Trails B scores (scores at the 0 to 33rd percentile) – indicating poor executive function ability – experienced no benefit with use of any of the regulation strategies, Dr. Smoski said.

No Trails B–dependent effects were seen among those without MDD.

"Participants with low executive function ability may have less ability to capitalize on conscious emotion regulation–strategy use to manage negative affect," she noted.

The findings indicate that executive function moderates emotion regulation in late-life depression and might have important implications for treatment in this population, Dr. Smoski said.

Since patients with late-life depression and poor executive function may have reduced response to standard interventions, referral for behavioral-activation therapy – a "promising and interesting treatment approach" – merits consideration, she said.

This study was supported by grants from the National Institutes of Health. Dr. Smoski reported having no other disclosures.

LOS ANGELES – Poor executive function ability in older patients with major depressive disorder was associated with reduced ability to implement emotion-regulation strategies in a prospective study involving 70 subjects.

The findings suggest that older patients with poor executive functioning might have a reduced capacity for benefiting from standard interventions for depression, such as cognitive-behavioral therapy, which rely on the implementation of emotion-regulation skills, Moria J. Smoski, Ph.D., reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

A total of 70 adults aged 60-87 years – 30 with major depressive disorder (MDD) and 40 without MDD – participated in the study. All subjects completed an emotion-regulation task involving stress induction achieved by ruminating for 2 minutes about a personally relevant stressor, followed by guided emotion regulation by either reappraisal or distraction techniques. A control group received no instruction on emotion regulation, said Dr. Smoski of Duke University Medical Center, Durham, N.C.

Mood was assessed using a three-item scale administered before and after stress induction, and at 1-minute intervals throughout the emotion-regulation phase. This protocol was repeated three times.

A subset of participants underwent neuropsychological executive-function testing, including a verbal fluency test (FAS) and assessment of task-switching and cognitive flexibility using the Trail Making Test-B (Trails B), Dr. Smoski said in an interview.

Subjects with MDD who had mid-level Trails B scores (scores at the 34th to 66th percentile) or high-level scores (scores at the 67th to 100th percentile) – indicating adequate or high levels of executive functioning – experienced significantly different degrees of negative affect reduction based on the emotion-regulation strategy used. The greatest decrease in negative affect scores was seen in those instructed to use distraction, followed by those instructed to use reappraisal and those who received no instruction on emotion regulation.

Subjects with low-level Trails B scores (scores at the 0 to 33rd percentile) – indicating poor executive function ability – experienced no benefit with use of any of the regulation strategies, Dr. Smoski said.

No Trails B–dependent effects were seen among those without MDD.

"Participants with low executive function ability may have less ability to capitalize on conscious emotion regulation–strategy use to manage negative affect," she noted.

The findings indicate that executive function moderates emotion regulation in late-life depression and might have important implications for treatment in this population, Dr. Smoski said.

Since patients with late-life depression and poor executive function may have reduced response to standard interventions, referral for behavioral-activation therapy – a "promising and interesting treatment approach" – merits consideration, she said.

This study was supported by grants from the National Institutes of Health. Dr. Smoski reported having no other disclosures.